Engaging Patient for Quality Improvement at St. Mary s Hospital Center, Montreal CAHSPR May 31, 2012 Brent Hopkins, Project Coordinator
Presentation Plan Introduction to CHSRF PEP Program Overview of St. Mary s Hospital PEP at St. Mary s objectives and progress-to-date Shared lessons and challenges from other PEP projects across Canada
CHSRF Patient Engagement Initiative Objective: Build the evidence base for patient engagement Promote and support intervention projects that engage patients in the design, delivery and evaluation of health services, and that lead to high-quality, patient-centered care. Funded by CHSRF, HCC and the Max Bell Foundation First RFP in 2010: First wave (2010): 10 projects x 2 yrs ($100K + matched $$) Second wave (2011): 7 projects x 2 yrs
Portrait of St. Mary s Secondary level community teaching hospital Designated CHAU 2008 271 acute care beds 1800 employees (600 nurses) 200 physicians Population served: allophones/english/french: 1/3:1/3:1/3 30% with incomes below Stats Canada low income limit
St. Mary s PEP Project Team Project Executive Bruce Brown Chair and Project Lead Patricia McDougall, Chair, Patient s Users Committee Marc Pineault, Coordinator - Quality and Risk Management Jeannie Haggerty, Chair in Family and Community Medicine Susan Law, VP Academic Affairs Brent Hopkins, Project Coordinator 3 program working groups St. Mary s Users Committee Expert advisory group
St. Mary s PEP project Parts 1. Users Committee and patient representatives 2. Navigation and orientation tools Cancer Care Emergency Mental Health 3. Knowledge transfer and exchange (KTE)
St. Mary s - PEP Parts (1) Users Committee and patient reps Objectives: Strengthen the role of patient representatives Support via training and hands-on learning to build capacity based in priority areas Anticipated outcomes: Higher confidence; better role clarity Better sense of priorities More partners and profile within the hospital
St. Mary s - Patient Involvement prior to PEP Pre-existing patient representation and engagement Long standing Users Committee, 18 clinical quality improvement teams, members of the board, ombudsman, clinical ethics committee, research ethics committee But Relatively few patient representatives Small community of patient representatives who are well engaged but few in numbers
Patient Representatives on Quality Improvement Teams and other Committees (2010-2011) QI team Pt Reps QI team/committee Pt Rep Cancer Care* None Environmental None Critical Care None Human Resources None Dialysis 1 Infection Control None Emergency 1 Information Mgmt None Family Medicine None Laboratories None Geriatrics None Pharmacy None Family Medicine None Radiology None Maternal Child 1 Rehab None Medicine 1 Mental Health 1 Users Committee 8 Surgery None Board of Directors 2 *Patient Voice (Cancer Care) 5 Ethics Committees 2
St. Mary s Users Committee All health and social service institutions in Quebec must have a users committee Mandate: Advise hospital management and partner with various departments Report to the hospital board of directors and CEO responsible for assuring proper functioning Main Roles: Inform users of their rights and obligations Defend the rights of users (patients) Promote the quality and improvement of services and living-conditions in hospital Ref: Users Committees - Reference Framework (MSSS)
Users Committee s Roles and Training Priorities Nov 29, 2010 Jan 28, 2011 Topic/Activity Participation and consent Meeting Group discussion re role clarity and effectiveness Results/ Successes/Challenges Concerns about time commitment Expressed interest in training Self-Identified Roles support and listen to patients advocate for patients report issues and patients needs to hospital management; influence change direct patients with formal complaints to ombudsman participate in/organize events and activities for patients promote the Users Committee
Users Committee s Roles and Training Priorities Feb 14, 2010 Method/Activity ID Challenges and Training Priorities Group Discussion Results/Feedback Expressed and observed challenges: Role clarity - overlapping roles, official government mandate Low profile among staff and patients Recruitment and representativeness Few systematic ways to obtain feedback from wider patient population Expressed and suggested training priorities: Training from provincial organization Workshops on committee skills, strategic planning sessions, communication etc. Information sessions (e.g. patient safety; patient satisfactions surveys; role of ombudsman; quality indicators, etc.)
Users Training Activities Dates April 11, 2011 Sept 21, 2011 Topic/Activity General Training from the Regroupement pronvincial des committees d usagers (RPCU) Teleconference - representative from Family Forum and Childrens Hospital of Eastern Ontario (CHEO) Oct 31-Nov 2, 2011 Participation in Patient Safety Week March 9, 2012 Workshop/Strategy Session on building profile How do we get ourselves out there?
Topic/Challenge Role clarity and confidence Communication with hospital administration Recruitment Reaching the wider patient voice Users Results and Observations Observations, Results Acting on lessons and advice from other patient advisory groups Clear understanding of desired role and interested Staff members attending regularly as a resource person at meetings Inviting senior manager for 10-15 min briefing at meetings UC identified recruitment as a priority and developing strategies Interested in activities to help patients more directly - still determining specific roles
St. Mary s - PEP Parts (2) Navigation and orientation tools Objectives: Engage patient representatives, patients, and staff as partners in the design and delivery of patient orientation tools in cancer care, mental health, emergency. Anticipated outcomes: Improved experience and satisfaction of care Decreased burden on front-line staff Road map for developing patient orientation tools Programs areas: Emergency, Cancer Care, Mental Health
Navigation and orientation tools Evaluation Plan Pre-post comparison of: Patient experience surveys (target: 200 in each program area) Staff interviews to assess navigational burden
PEP in the Emergency Department Working group: Chief of Emergency Department Medical writer (volunteer) Patient representative President Users Committee Navigational tools: Waiting-room slide-show Exam room posters Patient info area Welcome to the Emergency Department at St. Mary s Hospital
Welcome to the Emergency Department at St. Mary s Hospital
Emergency Department Process Please read each step carefully. 1. Triage 2. Registration 3. Medical Evaluation 4. Tests 5. Re-evaluation after tests 6. Discharge 7. Prescriptions/Follow up
4. Tests: Ultrasounds and CT scans If your doctor has ordered an ultrasound or a CT scan, you will be advised of the time of the test and where to go. If you have already had your test, there is a delay to the result being sent to the Emergency.
PEP in the Emergency Department Topic/Challenges Interest and participation among patients in the ED Observations No long-term relationship between patients and the system in the ED. Difficult to elicit feedback from patients. Difficult to recruit patients for focus groups Low response rates patient experience surveys Mail-out (26 responses/96 participants)= 26% Hand-out (21 responses/ 106 participants) = 20% Comfort with involvement volunteers, and users committee Few volunteers comfortable to collect feedback from patients in ED waiting room
PEP in Cancer Care Working Group: Program manager Program s psychologist Medical writer Patient Voice Professional Voice Patient Voice 5-6 patients Navigational Tools: Information session for newpatients Video introducing the clinic Update info and welcome before tumor board
PEP in Cancer Care Topic/Challenge Actively responding to patient feedback Observations Elements of care process changed in response to feedback from Patient Voice Competing priorities in a very busy clinical environment Process of engagement - Feedback from patient reps Writing materials for orientation session requires dedicated time. Patient Voice committee continues to assist with writing and editing. Keep it goal driven avoid therapy sessions Neutral mediator Fixed terms for patient participants Representativeness male patients, different age groups, different cancers types and treatments
Working group includes: social worker rehab therapist patient representative Psychologist outpatient nurse inpatient nurses Psychiatrist program manager PEP in Mental Health Navigational Tool: Orientation booklet to give information on the big picture consolidates general information from across the program
PEP in Mental Health Topic/Challenges Responding to patient needs Observations Orientation tool to respond directly to needs expressed by patients in focus groups Complex patient journey Consolidating information from across the program Challenge defining a window in trajectory for evaluation forced to expand the sample size Difficult to pull-together information from various clinical services within the program. Final production of booklet handed off to management - align with long-term vision Patient Participation and response rates Focus groups facilitated by patient rep Simple to recruit patients for focus groups Surveys (161 responses/229 approached) = 70%
St. Mary s - PEP Parts (3) Knowledge transfer and exchange (KTE) Objectives: Share experience of PEP projects at St. Mary s Address current knowledge gap within Quebec re patient engagement Elicit experiences and best practices from other Quebec institutions Dates June 6-7, 2011 April 25, 2012 June 21-22, 2012 Fall 2012 Events PEP 1 st Mid-project Meeting St. Mary s Research and Quality Symposium PT engagement PEP 2 nd Mid-project Meeting Symposium on Patient Engagement and Users Committees
Key Lessons from St. Mary s One size does not fit all three very different program areas Feedback from patients is useful and often unexpected Patients appreciate the opportunity to give feedback Patients feel comfortable speaking for themselves but are not ready to generalize Ownership with patients and frontline staff
Shared Challenges with other PEP teams Challenge Recruiting and retaining patients How do we recruit people who are not the usual suspects? Meaningful engagement? Science of patient engagement being relatively new How do we demonstrate this is effective? Continuous recruitment Concerns re representativeness; caregivers; clear terms of reference; incentives Goal driven; need to see results; involves all parties; one size does not fit all Difficult link between patient engagement and quality of care Few evaluation tools